Volume 8, Issue 5, May – 2023
ISSN No:-2456-2165
A Prospective Study on Acute Abdomen at Agogo
Presbyterian Hospital (APH), Ghana: Identification of
Common Causes and Pattern of Presentation
Godness Kye Biney1
(Principal Investigator)
Department of Biostatistics and Epidemiology, University of
Massachusetts Amherst Amherst, MA 01003 USA
Gilbert Lamptey3
Department of Nursing Kwame Nkrumah University of
Science and Technology
Kumasi, Ghana
Corresponding Author:- Godness Kye Biney1
Abstract:-
 Background
Acute abdomen is the most common presenting
surgical emergency in the world and due to its varied
etiology; it poses significant diagnostic challenges for
physicians.
 Objective
To examine the demographics and presentation
patterns of patients with acute abdomen (AA) who
sought treatment at Agogo Presbyterian Hospital (APH).
To determine the most common causes of AA, evaluate
accuracy of diagnosis by comparing pre-operative and
post– operative diagnosis of AA and determine the
morbidity and mortality associated with management of
the condition at APH.
 Methods
A descriptive, observational cross-sectional studies
which included all cases of AA diagnosed at APH within
the set study period. Standard forms were the primary
tool used for data collection. The variables studied
include patient demographics, clinical features, pattern
of presentations, complications and mortality. Data
gathered were coded and analyzed with the Statistical
Package for Social Sciences (SPSS) version 25.0
 Result
There were 26 patients, 11 males and 15 females.
The ages ranged from 1 to 69. The most common causes
of AA in APH were acute appendicitis 9(34.6%),
intestinal obstruction 5(19.2%), perforated peptic ulcer
disease 2(7.7%), typhoid ileal perforation 2(7.7%), acute
cholecystitis 2(7.7%) and severe PID (7.7%). 15 patients
underwent surgery (appendicectomy and exploratory
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International Journal of Innovative Science and Research Technology
Michael Sarfo2
Department of Public Health School of Human and Health
Sciences University of Huddersfield, UK
Dr. Frank Abebresse4
(Consultant Surgeon and Senior Lecturer)
Department of Physician Assistantship, Faculty of Health
and Medical Sciences, Presbyterian University College
Ghana Agogo, Ghana
laparotomy being the common operations), 11 were
managed conservatively. Three patients (11.5%) died,
two of whom were cases of perforated peptic ulcer
disease and died within three days of admission.
 Conclusion
This study highlights the need for accurate and
prompt diagnosis of AA, as it can be life-threatening.
Keywords:- Acute Abdomen; Acute Appendicitis; Abdominal
Pain; Peptic Ulcer Disease; Intestinal Obstruction; Ghana.
I. INTRODUCTION
Acute abdomen is a life-threatening abdominal
condition that has been increasing in prevalence globally
and is a common cause of admission to emergency
departments. [1,2]. It is a symptom complex that constitutes
a spectrum of surgical, medical, and gynecological
conditions requiring hospital admission, investigation, and
treatment. However, its relative incidence varies from place
to place and among populations, and the causes of acute
abdomen are several. [3] Therefore, a comprehensive
understanding of the common causes, pattern of
presentation, and diagnostic accuracy of acute abdomen is
crucial for early diagnosis and prompt treatment. The most
common causes of acute abdomen vary between developed
and developing countries. For instance, acute appendicitis is
the most common cause in developed countries, while
hernia and volvulus are most frequent in African
countries.[4] In West Africa, typhoid fever with ileal
perforation is also a common cause. Despite these findings,
little information is available about the pattern of
presentation of the etiologic spectrum of conditions resulting
in acute abdomen and factors affecting management
outcome such as diagnostic accuracy, especially in low
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resource settings. There is therefore the need to find out the
pattern of the disease and understand the background of
patients with acute abdomen and improve patient health
within few days considering the impact of its complications,
longer hospital stays, the financial burden and death
especially in low resource settings.
 Purpose of the Study
The study is intended to find out the frequencies and
patterns of different diseases presenting as acute abdomen
specific to the locality where the study is carried out; To
judge the importance and accuracy of clinical diagnosis by
comparing pre-operative and postoperative diagnosis; To
acquaint ourselves of the rare causes of acute abdomen
presenting in the common way managed at the Agogo
Presbyterian Hospital and prognostic features influencing
management outcome to further aid the effective medical
and surgical management of patients with acute abdomen.
 Objectives
 Main Objectives
To find the most common causes (etiological
spectrum) of acute abdomen, the pattern of presentation of
patients with acute abdomen and prognostic factors
influencing management outcome.
 Specific Objectives
 To determine the most common causes of acute
abdomen
 To evaluate accuracy of diagnosis by comparing pre
and post operative diagnosis of acute abdomen
 To identify the age, sex, occupation, and describe the
pattern of presentation of patients affected with acute
abdomen who reports to APH for management.
 To determine the morbidity and mortality associated
with management of the condition at APH
 Research Questions
 What are the most common causes of acute abdomen?
 What is the accuracy of pre-operative diagnosis to post-
operative diagnosis?
 What is the age, sex, occupation and pattern of
presentation of patients with acute abdomen?
 What is the morbidity and mortality associated with the
management of the condition at APH?
 Limitations of the Study
 Time constraint-The time was too short to enable
extensive recruitment of patients.
 Financial constraints
 Since the study was dependent on medical records,
inferences drawn from the comparison of pre-operative
and post-operative diagnosis and treatment outcomes
may have been underestimated due to exclusion of
incomplete records. Hence, selection bias is possible in
this study.
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International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
II. METHODS
This was a prospective descriptive observational cross-
sectional study carried out from October 2020 to February
2021 (period of 4 months) in the Agogo Presbyterian
hospital, Ghana.
Data was collected from the medical records of
patients to determine parameters such as age, sex, clinical
presentation, duration of symptoms, pre-existing conditions,
type of operation, post-operative diagnosis, and outcome in
terms of morbidities and mortalities. The duration of
symptoms was defined in days, and diagnoses were based
on detailed history, physical examination, and investigative
findings.
 Research Design
Descriptive observational cross-sectional study was
used to describe acute abdomen that presents at the Agogo
Presbyterian Hospital. The study employed descriptive
method to describe the characteristics of patients with acute
abdomen, common causes of acute abdomen, the pattern of
presentation of patients with acute abdomen and prognostic
factors influencing management outcome.
 Research Settings
The study was conducted at Agogo Presbyterian
Hospital, a mission hospital in the Asante Akyem District-
Ashanti Region. The hospital has specialized units and is
accredited for housemanship training in medicine, surgery,
paediatrics and obstetrics/gynaecology, and as a training
centre for Buruli ulcer treatment. It was selected for the
study because it receives nearly all cases of acute abdomen
in the area.
 Study Population
The study population consisted of cases of acute
abdomen diagnosed at APH within the four-months study
period.
 Inclusion Criteria
Patients of all age group both males and females who
have had any of the etiological spectrums of acute abdomen
diagnosed at APH and consented to the study were recruited
for the studies.
 Exclusion Criteria
The study excluded patients without a confirmed
diagnosis of acute abdomen, those who were not admitted
(OPD cases), patients less than one year old, those with
incomplete medical records, and those who could not take
full treatment due to financial, social, or other constraints.
 Sample Size and Sampling Method
Purposive or Convenient sample technique which is a
non-probability sampling method were used to select all
cases of acute abdomen that presented at the Agogo
Presbyterian hospital within the period who gave consent to
be included in sample size of respondents.
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 Method of Data Collection
To collect data for the study, we used standardized
collection forms and explained the purpose of the study to
patients in a language they could understand. The forms
were used to collect information on patient demographics,
clinical features, presentation patterns, complications, and
mortality. The collected data was then subjected to
reliability and validity tests, and both descriptive and
inferential statistical tools were used to analyze the data, in
order to accurately describe the characteristics of the
participants and identify any associations among the
variables studied.
 Method of Data Analysis
Information gathered from the standardized form was
coded and analyzed using a Statistical Package for the
Social Sciences (SPSS) version 25.0. The results were
presented by means of table, plot diagrams and graph.
 Ethical Considerations
Permission was obtained from the Agogo Presbyterian
Hospital Directorate. Permission was obtained from the
district health director of health services. Written informed
consent was obtained from respondents. Respondents were
assured of confidentiality.
III. RESULTS
A. Statistical Analysis
 Demographics
During the four months study period, there were
twenty-six (26) confirmed cases of acute abdomen of
varying etiologies in the Agogo Presbyterian hospital. 57.7%
(15) of these cases were managed surgically (operative
cases) whiles the remaining 42.3% (11) managed
conservatively (non-operative cases). There were 11(42.3%)
males and 15(57.7%) females with male to female ratio of
1:1.4 respectively. The age ranged from 01 to 69 with a
mean age of 31.46± 17.4(SD) years. Highest number of
patients was from the age group 20-29. 57.7% (15) of the
study population were insured under the National Health
Insurance Scheme whiles the remaining 42.3% (11) were
not insured. There were 12(46.2%) farmers among the study
population followed by 7(26.9) traders, 5(19.2%) students,
1(3.8%) hairdresser and 1(3.8%) unemployed. Of these,
15(57.7%) were illiterate, 6(23.1%) have had basic
education, 4(15.4%) have had secondary education and
1(3.8%) have had tertiary education. 11(42.3%) among the
26 cases were referred from other health facilities whiles the
remaining 15(57.7%) were diagnosed at APH.
 Patient Presentation
 Clinical Features
In this study, abdominal pain(100%) was the major
symptom presented in patients with acute abdomen while
vomiting 22(84.6%), nausea 10(38.5%), anorexia
8(30.8%),fever 7(26.9%), constipation 4(15.4%), chills 3(
11.5%), melena stools 2(7.7%), general body weakness 1(
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International Journal of Innovative Science and Research Technology
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3.8%), hematochezia 1( 3.8%),dysuria 1(3.8%), itching
1(3.8%) and weight loss 1(3.8%) were also present.
 Clinical Signs
Clinical signs elicited in the study include abdominal
tenderness 26(100%), Rebound tenderness 21(80.8%),
abdominal guarding 19(73.1%), abdominal distention
10(38.5%), rovsing sign 8(30.8), psoas sign 3(11.5%) and
jaundice 1(3.8%).
 Pattern of Presentation
Pattern of presentation of acute abdomen was
demarcated in relation to the pain, into onset, location,
intensity, frequency, character, radiation/referral and
duration of symptoms before presentation in this study. It
also took into account pre-existing conditions prior to the
development of acute abdomen. (Table 1)
14(53.8%) patients presented with sudden onset of
pain whiles the remaining 12(46.2%) were of gradual onset.
(Table 1)
Location of pain in this study was partitioned into
central abdomen, upper abdomen, lower abdomen and
generalized location. 11(42.3%) of the 26 cases had pain in
their lower abdomen, followed by 7(26.9%) in the
generalized location, 5(19.2%) in the upper abdomen and
3(11.5%) in the central abdomen.
Intensity of pain was accessed by using the pain rating
scale. 25(96.2%) patients among the total cases had severe
pain (greater/equal to 8) whiles the remaining patient (3.8%)
had a moderate pain during admission. (≥5≤8)
Frequency of pain was either constant or intermittent
in this study and among these options, 15(57.7%) patients
presented with constant pain whereas the remaining
11(42.3%) were of an intermittent frequency.
In terms of character of pain, 11(42.3%) described
their pain as cramping, 4(15.4%) had colicky pain, 2(7.7%)
were sharp whiles the remaining 9(34.6%) patients were not
able to describe (vague).
As regards radiation/referral of pain, 16(61.5%) of j
patients had no radiation/referral of pain, 7(26.9%) were
unable to express, 2(7.7%) had their pain radiating/referring
to the epigastrium and 1(3.8%) to the back.
The duration of symptoms ranged from 4hours to
7days (mean=3.0). 11(42.3%) presented in less than two
days (within 48hours) whereas 15(57.7%) presented to the
hospital after two days.
Among the 26 cases, 17(65.4%) had no pre- existing
condition prior to the development of acute abdomen but
then 3(. 11.5%) were hypertensive, 3(11.5%) were peptic
ulcer disease patients, 1(3.8%) was diagnosed of chronic
kidney disease and 2(7.7%) were pregnant.
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Table 1 Displaying the Pattern of Presentation
Variables Frequency Percentage (%)
Onset Of Pain
Sudden 14 53.8
Gradual 12 46.2
Total 26 100.0
Location Of Pain
Central Abdomen 3 11.5
Upper Abdomen 5 19.2
Lower Abdomen 11 42.3
Generalized 7 26.9
Total 26 100.0
Intensity Of Pain
Severe 25 96.2
Moderate 1 3.8
Total 26 100.0
Frequency Of Pain
Constant 15 57.7
Intermittent 11 42.3
Total 26 100.0
Character Of Pain
Colicky 4 15.4
Cramping 11 42.3
Sharp 2 7.7
Vague/Can’t Describe 9 34.6
Total 26 100.0
Radiation/Referral Of Pain
None 16 61.5
Back 1 3.8
Unable To Express 7 26.9
Epigastrium 2 7.7
Total 26 100.0
Duration Of Symptoms
Less Than Two Days 11 42.3
Greater Than Two Days 15 57.7
Total 26 100.0
Pre-Existing Condition Prior To Acute Abdomen
Chronic Kidney Disease 1 3.8
Hypertension 3 11.5
None 17 65.4
Peptic Ulcer Disease 3 11.5
Pregnancy 2 7.7
Total 26 100.0

 Common Causes of Acute Abdomen

On analyzing the spectrum of disease in all the 26 cases, it was found out that acute appendicitis was the most common
causes of acute abdomen which was found in 9(34.6%) followed by intestinal obstruction in 5(19.2%),perforated peptic ulcer
disease in 2(7.7%), typhoid ileal perforation in 2(7.7%), acute cholecystitis in 2(7.7%), severe pelvic inflammatory disease(PID)
in 2( 7.7%) of the total patients studied and one case each of acute pancreatitis (3.8%), acute gastritis (3.8%), ruptured ectopic
pregnancy (3.8%) and spontaneous bacterial peritonitis (3.8%).( Table 2)

In summary, there were 23(88.5%) gastrointestinal causes of acute abdomen (medical and surgical) with the remaining
3(11.5%) of gynecological causes.

Table 2 Displaying the Common Causes of Acute Abdomen

Condition Frequency Percentages
Acute appendicitis 9 34.6%
Intestinal obstruction 5 19.2%
Perforated PUD 2 7.7%

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Typhoid Ileal perforation 2 7.7%
Acute cholecystitis 2 7.7%
Severe PID 2 7.7%
Acute pancreatitis 1 3.8%
Acute gastritis 1 3.8%
Ruptured ectopic pregnancy 1 3.8%
SBP 1 3.8%
TOTAL 26 100%

 Pre-Operative and Post- Operative Diagnosis

There were 3(11.5%) wrong pre-operative diagnosis out of the total 15 surgically managed cases in comparison with the
post-operative diagnosis (Table 3).

Table 3 Displaying Pre- Operative and Post- Operative Diagnosis of Acute Abdomen
Pre-Operative Diagnosis
Frequency Percent Valid Percent Cumulative Percent
Acute Appendicitis 9 34.6 60.0 60.0
Intestinal Obstruction 4 15.4 26.7 86.7
Perforated peptic ulcer disease 2 7.7 13.3 100.0
Total 15 57.7 100.0
Post-Operative Diagnosis
Acute Appendicitis 8 30.8 53.3 53.3
Intestinal Obstruction 2 7.7 13.3 66.7
Typhoid Ileal Perforation 2 7.7 13.3 80.0
Ruptured Ectopic Pregnancy 1 3.8 6.7 86.7
Appendicitis In Pregnancy 1 3.8 6.7 93.3
Perforated peptic ulcer disease 1 3.8 6.7 100.0
Total 15 57.7 100.0

 Morbidity and Mortality In this study, out of the 26 consecutive patients

 Morbidity
Post-operative complications occurred in 2(7.7%)
patients in the study. The post-operative morbidity that
occurred is abdominal compartment syndrome and wound
infection. It was dressed and treated. Among the 11(42.3%)
non- operated patients, 2(7.7%) developed complications
which were shock and spontaneous bacteria peritonitis. The
rest of the patients did not develop any complications.
 Mortality
The overall mortality present in this study was 11.5%.
There was 3.8% (1) post-operative mortality and 7.7% (2)
non- operative mortality. There were all non- insured
farmers who had pre-existing conditions. The causes of
death were shock due to rupture of intra-abdominal viscous
(PUD), abdominal compartment syndrome following
perforated PUD operation and spontaneous bacteria
peritonitis. All these deaths occurred within 3 days of
admission with 67% (⅔) occurring within 48hours.
IV. DISCUSSION
Acute abdomen is the most common presenting
surgical emergency in all part of the world. Despite
improvement in clinical evaluations and advancement in
diagnostic methods, correct diagnosis of acute abdomen is
still sometimes difficult. [5]
recruited into this study, 11 were males while 15 were
females with a male to female ratio of 1: 1.4. There was a
female dominance in this study which is consistent with
findings of A. Murata et al., 2014(Ethiopia) but in contrast
with study findings of Professor Ohene M. Yeboah who
reported male dominance in his six years prospective study
on 3114 patients in Kumasi, Ghana and other researchers
across the globe [6–8]. The mean age of patients was
31.46±17.4 years with age range of 1 to 69 which is similar
in findings to a study conducted by Gebrie et.al who
reported the same age range and mean but inconsistent with
study findings from Laal M and Mardanloo A who reported
mean age of 35.3±18.6 with age range of 9-85. Majority of
patients were in their second and third decades of life
consistent with study findings in tertiary hospitals in India
and Kigali teaching hospital. [9]
The duration of symptoms ranged from 4 hours to 7
days with mean of 3.0 days and 15(57.7%) patients came to
the hospital after two days consistent with findings of
Gebrie et.al, 2009 but just like in a study conducted in
Kigali teaching hospital by Nyundo M et.al, the duration of
symptoms had no association with morbidity and mortality
in this study. The commonest symptom in this study was
abdominal pain (100%) followed by vomiting (84%). In a
study conducted by Beyene H et.al in 2019, the commonest
symptom was abdominal pain (100%) followed by vomiting
(80%) consistent with findings of Chanana et.al reporting
abdominal pain (100%) as the commonest symptom

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followed by vomiting (57.2%), hence, symptoms in this
study have similar findings compared with studies
mentioned earlier with abdominal pain and vomiting as the
commonest symptoms observed in patients with acute
abdomen. In general, abdominal pain (100%), vomiting
(84%), nausea (38.5%), anorexia (30.8%), fever (26.9%)
and constipation (15.4%) were the common presenting
complaints in this study which is in agreement with other
studies [10–12].The commonest sign elicited in this study
was abdominal tenderness (100%) followed by rebound
tenderness (80.8%) and abdominal guarding (73.1%)
consistent with other study findings[6,12]. Common things
occur commonly, and as acute appendicitis is the most
common cause of acute abdomen across the globe so was it
the most common cause in this study followed by intestinal
obstruction, gastro-duodenal and typhoid ileal perforation
which is in agreement with findings of Professor Ohene M.
Yeboah and other researchers worldwide. [3,13] However,
these findings were inconsistent with the results of SB
Naaeder and EQ Archampong's study conducted in Accra,
Ghana.
The pattern of presentation of acute abdomen in Africa
especially Sub- Saharan Africa follows almost the same
pattern as acute appendicitis, intestinal obstruction,
perforated peptic ulcer disease and typhoid ileal perforation
but then this differs from that of the developed world ; for
instance, in a study conducted from Boston,
Massachuset(USA), urinary tract stone(31.4%),
appendicitis(23.6%), intra-abdominal abscess(17%),
diverticulitis(16.9%) and small bowel obstruction(10.6%)
were the commonest cause of acute abdomen. [14,15]
Pre-operative diagnosis was wrong in 20% (3/15) of
surgical cases indicating the need for using other diagnostic
tool besides detailed history, clinical examination and
routine investigations as proposed by Dr. Muhammad Asif
et.al in their study on the causes of acute abdomen in 2002.
The overall mortality in this study was 11.5% which is
lower than the study done in Tikur Anbesa Specialized
hospital (18.6%) and Goba referral hospital (16%) but
higher than study done in Mekelele and Nekemte referral
hospitals which shown 2.4% and 3.05% mortality rate
respectively.[4,9] The most fatal cause of acute abdomen in
this study was perforated peptic ulcer disease. These deaths
can be attributed to the fact that they were all non- insured
illiterate farmers who had pre-existing conditions and aged
above forty-years.
V. CONCLUSION
Acute abdomen remains the most common presenting
surgical emergency that poses diagnostic challenges for
physicians due to its varied etiology. The results showed that
the most common causes of acute abdomen in the APH were
acute appendicitis and intestinal obstruction, with most
cases being managed surgically. The study also showed that
the accuracy of diagnosis was relatively high and that the
morbidity and mortality associated with the management of
acute abdomen were low. However, it is important to note
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International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
that some patients died after developing post-operative
complications or while awaiting surgery, highlighting the
need for prompt and effective management of this condition.
Moreover, it was revealed in this study that illiterates were
most affected in terms of prevalence, development of
morbidities and mortalities hence public health initiatives
targeting these people should be initiated to empower them
about healthy living, compliance to medication when
diagnosed of any chronic condition and ensuring that they
are registered under the National Health Insurance Scheme
so they can enjoy all the benefits that comes with it.
 Guarantor
I accept full responsibility for the work, had access to
the data and made decision to publish.
 Declaration of Competing Interest
There is no conflict of interest in this study.
 Declaration on Ethical Considerations
Research was approved by Presbyterian University
College Ghana Institutional Review Board. Permission was
obtained from the Agogo Presbyterian Hospital Directorate.
Permission was obtained from the district health director of
health services. Written informed consent was obtained from
respondents.
 Sources of Funding for your Research
No funding was received for this study.
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